The present study was performed to assess, beyond
socio-economic factors, independent associations
between the health and nutritional status of children
under 5 years old and (1) family behavioural factors
related to women with regard to child care and (2)
war-related experience by the household of hardships
in Afghanistan.

Methods

The subjects were all children born during the
previous 5 years from 1400 households in Kabul
Province, Afghanistan and were selected by multistage
sampling in March 2006. Height and weight measurements
of the children and culturally sensitive interviews
with their mothers were conducted by household visits.
Child mortality, morbidity and nutritional status were
evaluated. Four areas were assessed as variables for
family behavioural factors related to women: education
of mothers, child marriage of the mothers, maternal
autonomy in obtaining healthcare for children and
preference for a female physician. Hardships
experienced by the family were examined by determining
their satisfaction of basic material needs and by any
experience of being forced to leave a preferred
residence.

Results

A total of 2474 children from 1327 households
completed the examinations and interviews; among them,
101 children were deceased by the time of the
interview visits. Diarrhoea (32.5%) and acute
respiratory infection (41.0%) were common child health
problems and both emaciation (12.4%) and linear growth
retardation (39.9%) were prevalent. Regardless of the
influence of economic, demographic, family behavioural
or hardships experience factors, a lack of maternal
autonomy (79.1%) was associated with the occurrence of
acute respiratory infection (odds-ratio = 1.72; 95%
confidence interval = 1.23, 2.40), and linear growth
retardation of children (odds-ratio = 1.38; 95%
confidence interval = 1.01, 1.90); a lack of education
of the mother (71.7%) and child marriage of the
mothers (18.3%) were associated with diarrhoea
(odds-ratio = 1.84; 95% confidence interval = 1.40,
2.41; odds-ratio = 1.46; 95% confidence interval =
1.08, 1.96, respectively); a shortage of basic
material needs (59.1%) was associated with diarrhoea
(odds-ratio = 1.35; 95% confidence interval = 1.08,
1.68); and migration inside the country (52.9%) was
associated with underweight children (odds-ratio =
2.48; 95% confidence interval = 1.13, 5.44).

Conclusions

A lack of education of the mothers, child marriage,
lack of maternal autonomy, shortage of basic material
needs and internal displacement showed independent and
significant negative associations with child health
and nutritional variables in this country that has
experienced a long period of conflict.

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